Am I a Drug Addiction? – Complete the Questionnaire

Do you suspect you or a loved one could be addicted to drugs? If so, complete the below drug addiction questionnaire. Doing so will assist you in determining whether or not a drug addiction has arisen.

NameEmailPhone Number

1.

Do you avoid family and friends because of your drinking?

Yes

No

2.

Do you drink alcohol to suppress negative emotions such as stress, disappointment and anger?

Yes

No

3.

Has your tolerance for alcohol increased significantly since you first began to drink?

Yes

No

4.

Have you ever experienced a blackout because of your drinking so you are unable to recall part of the previous evening when you drank?

Yes

No

5.

When drinking with friends, do you attempt to drink a few extra drinks whilst these people are not looking?

Yes

No

6.

Do you experience anxiety when you know alcohol will not be accessible for you, even if it is just for a few hours?

Yes

No

7.

Do you feel emotionally hurried to drink the first drink of the day?

Yes

No

8.

Do you experience guilt and shame because of your drinking?

Yes

No

9.

Do family members or friends express concern about your drinking?

Yes

No

10.

Do you continue to drink even when you friends or loved ones say they cannot drink anymore?

Yes

No

11.

Do you drink heavily even though there is no social reason to do so?

Yes

No

12.

Following a drinking session, do you ever experience regret for the things you have said or done whilst drunk?

Yes

No

13.

Do you regularly tell yourself you will never drink again but this promise always falls flat?

Yes

No

14.

Have you ever drunk alcohol whilst at work?

Yes

No

15.

Is alcohol disrupting work, school or family life?

Yes

No

16.

Has your doctor advised you to either stop or cut down on your drinking?

Yes

No

17.

Do you ever drink a little alcohol to stop your hands from shaking?

Yes

No

18.

Have you sought help for your drinking?

Yes

No

19.

Does your drinking help to ease the symptoms of depression or anxiety?

Yes

No

20.

Have blood relatives suffered from alcoholism in the past or currently?